|
INSERTION OF SINUS TARSI IMPLANT
|
Facility
|
IP
|
$6,331.00
|
|
|
Service Code
|
CPT 0335T
|
| Hospital Charge Code |
6103350
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,728.36 |
| Max. Negotiated Rate |
$6,014.45 |
| Rate for Payer: Cash Price |
$3,798.60
|
| Rate for Payer: Cigna Commercial |
$5,381.35
|
| Rate for Payer: First Health Commercial |
$5,697.90
|
| Rate for Payer: First Health Workers Compensation |
$2,444.40
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,697.90
|
| Rate for Payer: GEHA Commercial |
$4,431.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,697.90
|
| Rate for Payer: Multiplan All |
$5,761.21
|
| Rate for Payer: OMNI Networks Commercial |
$4,431.70
|
| Rate for Payer: One Health Plan PPO/POS |
$5,697.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$6,014.45
|
| Rate for Payer: Three Rivers Provider Network All |
$4,748.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,887.83
|
| Rate for Payer: Zelis Auto |
$2,532.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,728.36
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$6,099.72
|
|
|
Service Code
|
CPT 36561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,438.17 |
| Max. Negotiated Rate |
$6,099.72 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$3,077.72
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$2,438.17
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$3,049.86
|
| Rate for Payer: First Health Workers Compensation |
$3,925.17
|
| Rate for Payer: GEHA Medicare |
$3,049.86
|
| Rate for Payer: Humana ChoiceCare |
$3,354.85
|
| Rate for Payer: Humana Medicare Advantage |
$3,049.86
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$5,123.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$2,487.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$3,049.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$5,184.76
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$2,872.53
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$2,487.82
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$3,049.86
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$6,099.72
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,988.86
|
| Rate for Payer: United Healthcare Managed Medicaid |
$2,487.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,049.86
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$3,049.86
|
| Rate for Payer: Zelis Medicare |
$2,592.38
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,659.83
|
| Rate for Payer: Zelis Worker's Compensation |
$2,775.37
|
|
|
INSERTION OR REPLACEMENT OF PERCUTANEOUS ELECTRODE ARRAY, PERIPHERAL NERVE, WITH INTEGRATED NEUROSTIMULATOR, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED; INITIAL ELECTRODE ARRAY
|
Facility
|
OP
|
$24,166.96
|
|
|
Service Code
|
CPT 64596
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,270.96 |
| Max. Negotiated Rate |
$24,166.96 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$12,083.48
|
| Rate for Payer: First Health Workers Compensation |
$15,551.44
|
| Rate for Payer: GEHA Medicare |
$12,083.48
|
| Rate for Payer: Humana ChoiceCare |
$13,291.83
|
| Rate for Payer: Humana Medicare Advantage |
$12,083.48
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$20,300.25
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$12,083.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$20,541.92
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$12,083.48
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$24,166.96
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$11,841.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,083.48
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$12,083.48
|
| Rate for Payer: Zelis Medicare |
$10,270.96
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$14,500.18
|
| Rate for Payer: Zelis Worker's Compensation |
$10,995.97
|
|
|
INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$59,056.60
|
|
|
Service Code
|
CPT 63685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,508.40 |
| Max. Negotiated Rate |
$59,056.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$20,838.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$20,838.67
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$16,508.40
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$29,528.30
|
| Rate for Payer: First Health Workers Compensation |
$38,002.92
|
| Rate for Payer: GEHA Medicare |
$29,528.30
|
| Rate for Payer: Humana ChoiceCare |
$32,481.13
|
| Rate for Payer: Humana Medicare Advantage |
$29,528.30
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$49,607.54
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$16,844.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$29,528.30
|
| Rate for Payer: New Mexico Health Connections Medicare |
$50,198.11
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$19,449.43
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$16,844.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$29,528.30
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$59,056.60
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$28,937.73
|
| Rate for Payer: United Healthcare Managed Medicaid |
$16,844.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,528.30
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$29,528.30
|
| Rate for Payer: Zelis Medicare |
$25,099.06
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$35,433.96
|
| Rate for Payer: Zelis Worker's Compensation |
$26,870.75
|
|
|
INSERTION PICC W/O IMG GDN < 5 YR
|
Facility
|
IP
|
$1,728.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
336568
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$471.74 |
| Max. Negotiated Rate |
$1,641.60 |
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$1,468.80
|
| Rate for Payer: First Health Commercial |
$1,555.20
|
| Rate for Payer: First Health Workers Compensation |
$667.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,555.20
|
| Rate for Payer: GEHA Commercial |
$1,209.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,555.20
|
| Rate for Payer: Multiplan All |
$1,572.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,209.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,555.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,641.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,296.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,607.04
|
| Rate for Payer: Zelis Auto |
$691.20
|
| Rate for Payer: Zelis Worker's Compensation |
$471.74
|
|
|
INSERTION PICC W/O IMG GDN 5 YR/>
|
Facility
|
OP
|
$3,048.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
3736569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$894.39 |
| Max. Negotiated Rate |
$3,010.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,828.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$894.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,505.25
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$2,590.80
|
| Rate for Payer: First Health Commercial |
$2,743.20
|
| Rate for Payer: First Health Workers Compensation |
$1,937.26
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,743.20
|
| Rate for Payer: GEHA Commercial |
$2,438.40
|
| Rate for Payer: GEHA Medicare |
$1,505.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,743.20
|
| Rate for Payer: Humana ChoiceCare |
$1,655.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,505.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,528.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$912.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,505.25
|
| Rate for Payer: Multiplan All |
$2,773.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,558.93
|
| Rate for Payer: OMNI Networks Commercial |
$2,133.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,743.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,053.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$912.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,505.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,895.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,010.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,475.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$912.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,505.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,834.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,505.25
|
| Rate for Payer: Zelis Auto |
$1,219.20
|
| Rate for Payer: Zelis Medicare |
$1,279.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,806.30
|
| Rate for Payer: Zelis Worker's Compensation |
$1,369.78
|
|
|
INSERTION PICC W/O IMG GDN 5 YR/>
|
Facility
|
OP
|
$3,861.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
1900049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.39 |
| Max. Negotiated Rate |
$3,667.95 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,316.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$894.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,505.25
|
| Rate for Payer: Cash Price |
$2,316.60
|
| Rate for Payer: Cash Price |
$2,316.60
|
| Rate for Payer: Cigna Commercial |
$3,281.85
|
| Rate for Payer: First Health Commercial |
$3,474.90
|
| Rate for Payer: First Health Workers Compensation |
$1,490.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,474.90
|
| Rate for Payer: GEHA Commercial |
$3,088.80
|
| Rate for Payer: GEHA Medicare |
$1,505.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,474.90
|
| Rate for Payer: Humana ChoiceCare |
$1,655.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,505.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,528.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$912.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,505.25
|
| Rate for Payer: Multiplan All |
$3,513.51
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,558.93
|
| Rate for Payer: OMNI Networks Commercial |
$2,702.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,474.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,053.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$912.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,505.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,667.95
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,010.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,895.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,475.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$912.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,505.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,590.73
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,505.25
|
| Rate for Payer: Zelis Auto |
$1,544.40
|
| Rate for Payer: Zelis Medicare |
$1,279.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,806.30
|
| Rate for Payer: Zelis Worker's Compensation |
$1,054.05
|
|
|
INSERTION PICC W/O IMG GDN 5 YR/>
|
Facility
|
IP
|
$3,048.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
1000054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$832.10 |
| Max. Negotiated Rate |
$2,895.60 |
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$2,590.80
|
| Rate for Payer: First Health Commercial |
$2,743.20
|
| Rate for Payer: First Health Workers Compensation |
$1,176.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,743.20
|
| Rate for Payer: GEHA Commercial |
$2,133.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,743.20
|
| Rate for Payer: Multiplan All |
$2,773.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,133.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,743.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,895.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,834.64
|
| Rate for Payer: Zelis Auto |
$1,219.20
|
| Rate for Payer: Zelis Worker's Compensation |
$832.10
|
|
|
INSERTION PICC W/O IMG GDN 5 YR/>
|
Facility
|
OP
|
$3,048.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
6136569
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$832.10 |
| Max. Negotiated Rate |
$3,010.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,828.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$894.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,505.25
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$2,590.80
|
| Rate for Payer: First Health Commercial |
$2,743.20
|
| Rate for Payer: First Health Workers Compensation |
$1,176.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,743.20
|
| Rate for Payer: GEHA Commercial |
$2,438.40
|
| Rate for Payer: GEHA Medicare |
$1,505.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,743.20
|
| Rate for Payer: Humana ChoiceCare |
$1,655.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,505.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,528.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$912.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,505.25
|
| Rate for Payer: Multiplan All |
$2,773.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,558.93
|
| Rate for Payer: OMNI Networks Commercial |
$2,133.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,743.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,053.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$912.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,505.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,895.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,010.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,475.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$912.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,505.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,834.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,505.25
|
| Rate for Payer: Zelis Auto |
$1,219.20
|
| Rate for Payer: Zelis Medicare |
$1,279.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,806.30
|
| Rate for Payer: Zelis Worker's Compensation |
$832.10
|
|
|
INSERTION PICC W/O IMG GDN 5 YR/>
|
Facility
|
OP
|
$3,048.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
8136568
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$832.10 |
| Max. Negotiated Rate |
$3,010.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,828.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,128.99
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$894.39
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,505.25
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$2,590.80
|
| Rate for Payer: First Health Commercial |
$2,743.20
|
| Rate for Payer: First Health Workers Compensation |
$1,176.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,743.20
|
| Rate for Payer: GEHA Commercial |
$2,438.40
|
| Rate for Payer: GEHA Medicare |
$1,505.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,743.20
|
| Rate for Payer: Humana ChoiceCare |
$1,655.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,505.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,528.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$912.60
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,505.25
|
| Rate for Payer: Multiplan All |
$2,773.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,558.93
|
| Rate for Payer: OMNI Networks Commercial |
$2,133.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,743.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,053.72
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$912.60
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,505.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,895.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,010.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,475.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$912.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,505.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,834.64
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,505.25
|
| Rate for Payer: Zelis Auto |
$1,219.20
|
| Rate for Payer: Zelis Medicare |
$1,279.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,806.30
|
| Rate for Payer: Zelis Worker's Compensation |
$832.10
|
|
|
INSERTION PICC W/O IMG GDN 5 YR/>
|
Facility
|
IP
|
$3,048.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
336569
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$832.10 |
| Max. Negotiated Rate |
$2,895.60 |
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$2,590.80
|
| Rate for Payer: First Health Commercial |
$2,743.20
|
| Rate for Payer: First Health Workers Compensation |
$1,176.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,743.20
|
| Rate for Payer: GEHA Commercial |
$2,133.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,743.20
|
| Rate for Payer: Multiplan All |
$2,773.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,133.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,743.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,895.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,834.64
|
| Rate for Payer: Zelis Auto |
$1,219.20
|
| Rate for Payer: Zelis Worker's Compensation |
$832.10
|
|
|
INSERTION PICC W/O IMG GDN 5 YR/>
|
Facility
|
IP
|
$3,861.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
1900049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,054.05 |
| Max. Negotiated Rate |
$3,667.95 |
| Rate for Payer: Cash Price |
$2,316.60
|
| Rate for Payer: Cigna Commercial |
$3,281.85
|
| Rate for Payer: First Health Commercial |
$3,474.90
|
| Rate for Payer: First Health Workers Compensation |
$1,490.73
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$3,474.90
|
| Rate for Payer: GEHA Commercial |
$2,702.70
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$3,474.90
|
| Rate for Payer: Multiplan All |
$3,513.51
|
| Rate for Payer: OMNI Networks Commercial |
$2,702.70
|
| Rate for Payer: One Health Plan PPO/POS |
$3,474.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$3,667.95
|
| Rate for Payer: Three Rivers Provider Network All |
$2,895.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$3,590.73
|
| Rate for Payer: Zelis Auto |
$1,544.40
|
| Rate for Payer: Zelis Worker's Compensation |
$1,054.05
|
|
|
INSERTION PICC W/O IMG GDN 5 YR/>
|
Facility
|
IP
|
$3,048.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
3736569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$832.10 |
| Max. Negotiated Rate |
$2,895.60 |
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$2,590.80
|
| Rate for Payer: First Health Commercial |
$2,743.20
|
| Rate for Payer: First Health Workers Compensation |
$1,176.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,743.20
|
| Rate for Payer: GEHA Commercial |
$2,133.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,743.20
|
| Rate for Payer: Multiplan All |
$2,773.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,133.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,743.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,895.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,834.64
|
| Rate for Payer: Zelis Auto |
$1,219.20
|
| Rate for Payer: Zelis Worker's Compensation |
$832.10
|
|
|
INSERTION PICC W/O IMG GDN 5 YR/>
|
Facility
|
IP
|
$3,048.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
6136569
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$832.10 |
| Max. Negotiated Rate |
$2,895.60 |
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$2,590.80
|
| Rate for Payer: First Health Commercial |
$2,743.20
|
| Rate for Payer: First Health Workers Compensation |
$1,176.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,743.20
|
| Rate for Payer: GEHA Commercial |
$2,133.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,743.20
|
| Rate for Payer: Multiplan All |
$2,773.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,133.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,743.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,895.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,834.64
|
| Rate for Payer: Zelis Auto |
$1,219.20
|
| Rate for Payer: Zelis Worker's Compensation |
$832.10
|
|
|
INSERTION PICC W/O IMG GDN 5 YR/>
|
Facility
|
IP
|
$3,048.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
8136568
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$832.10 |
| Max. Negotiated Rate |
$2,895.60 |
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cigna Commercial |
$2,590.80
|
| Rate for Payer: First Health Commercial |
$2,743.20
|
| Rate for Payer: First Health Workers Compensation |
$1,176.83
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,743.20
|
| Rate for Payer: GEHA Commercial |
$2,133.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,743.20
|
| Rate for Payer: Multiplan All |
$2,773.68
|
| Rate for Payer: OMNI Networks Commercial |
$2,133.60
|
| Rate for Payer: One Health Plan PPO/POS |
$2,743.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,895.60
|
| Rate for Payer: Three Rivers Provider Network All |
$2,286.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,834.64
|
| Rate for Payer: Zelis Auto |
$1,219.20
|
| Rate for Payer: Zelis Worker's Compensation |
$832.10
|
|
|
INSERTION PICC W/RS&I < 5 YR
|
Facility
|
IP
|
$1,728.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
1000055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$471.74 |
| Max. Negotiated Rate |
$1,641.60 |
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$1,468.80
|
| Rate for Payer: First Health Commercial |
$1,555.20
|
| Rate for Payer: First Health Workers Compensation |
$667.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,555.20
|
| Rate for Payer: GEHA Commercial |
$1,209.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,555.20
|
| Rate for Payer: Multiplan All |
$1,572.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,209.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,555.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,641.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,296.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,607.04
|
| Rate for Payer: Zelis Auto |
$691.20
|
| Rate for Payer: Zelis Worker's Compensation |
$471.74
|
|
|
INSERTION PICC W/RS&I < 5 YR
|
Facility
|
IP
|
$1,728.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
6136572
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$471.74 |
| Max. Negotiated Rate |
$1,641.60 |
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$1,468.80
|
| Rate for Payer: First Health Commercial |
$1,555.20
|
| Rate for Payer: First Health Workers Compensation |
$667.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,555.20
|
| Rate for Payer: GEHA Commercial |
$1,209.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,555.20
|
| Rate for Payer: Multiplan All |
$1,572.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,209.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,555.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,641.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,296.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,607.04
|
| Rate for Payer: Zelis Auto |
$691.20
|
| Rate for Payer: Zelis Worker's Compensation |
$471.74
|
|
|
INSERTION PICC W/RS&I < 5 YR
|
Facility
|
IP
|
$1,728.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
336572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$471.74 |
| Max. Negotiated Rate |
$1,641.60 |
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$1,468.80
|
| Rate for Payer: First Health Commercial |
$1,555.20
|
| Rate for Payer: First Health Workers Compensation |
$667.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,555.20
|
| Rate for Payer: GEHA Commercial |
$1,209.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,555.20
|
| Rate for Payer: Multiplan All |
$1,572.48
|
| Rate for Payer: OMNI Networks Commercial |
$1,209.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,555.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,641.60
|
| Rate for Payer: Three Rivers Provider Network All |
$1,296.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,607.04
|
| Rate for Payer: Zelis Auto |
$691.20
|
| Rate for Payer: Zelis Worker's Compensation |
$471.74
|
|
|
INSERTION PICC W/RS&I < 5 YR
|
Facility
|
OP
|
$1,728.00
|
|
|
Service Code
|
CPT 36572
|
| Hospital Charge Code |
6136572
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$471.74 |
| Max. Negotiated Rate |
$1,641.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$930.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,036.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$930.01
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$736.76
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$599.08
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$1,468.80
|
| Rate for Payer: First Health Commercial |
$1,555.20
|
| Rate for Payer: First Health Workers Compensation |
$667.18
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$1,555.20
|
| Rate for Payer: GEHA Commercial |
$1,382.40
|
| Rate for Payer: GEHA Medicare |
$599.08
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$1,555.20
|
| Rate for Payer: Humana ChoiceCare |
$658.99
|
| Rate for Payer: Humana Medicare Advantage |
$599.08
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$1,006.45
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$751.76
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$599.08
|
| Rate for Payer: Multiplan All |
$1,572.48
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,018.44
|
| Rate for Payer: OMNI Networks Commercial |
$1,209.60
|
| Rate for Payer: One Health Plan PPO/POS |
$1,555.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$868.01
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$751.76
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$599.08
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$1,641.60
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$1,198.16
|
| Rate for Payer: Three Rivers Provider Network All |
$1,296.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$587.10
|
| Rate for Payer: United Healthcare Managed Medicaid |
$751.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$599.08
|
| Rate for Payer: United Payors & United Providers UP&UP |
$1,607.04
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$599.08
|
| Rate for Payer: Zelis Auto |
$691.20
|
| Rate for Payer: Zelis Medicare |
$509.22
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$718.90
|
| Rate for Payer: Zelis Worker's Compensation |
$471.74
|
|
|
INSERTION PICC W/RS&I 5 YR/>
|
Facility
|
OP
|
$3,046.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
8136573
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$831.56 |
| Max. Negotiated Rate |
$3,010.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,640.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,827.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,640.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,299.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,505.25
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$2,589.10
|
| Rate for Payer: First Health Commercial |
$2,741.40
|
| Rate for Payer: First Health Workers Compensation |
$1,176.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,741.40
|
| Rate for Payer: GEHA Commercial |
$2,436.80
|
| Rate for Payer: GEHA Medicare |
$1,505.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,741.40
|
| Rate for Payer: Humana ChoiceCare |
$1,655.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,505.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,528.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,326.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,505.25
|
| Rate for Payer: Multiplan All |
$2,771.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,558.93
|
| Rate for Payer: OMNI Networks Commercial |
$2,132.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,741.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,531.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,326.03
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,505.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,893.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,010.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,284.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,475.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,326.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,505.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,832.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,505.25
|
| Rate for Payer: Zelis Auto |
$1,218.40
|
| Rate for Payer: Zelis Medicare |
$1,279.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,806.30
|
| Rate for Payer: Zelis Worker's Compensation |
$831.56
|
|
|
INSERTION PICC W/RS&I 5 YR/>
|
Facility
|
OP
|
$3,046.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
6136573
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$831.56 |
| Max. Negotiated Rate |
$3,010.50 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$1,640.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,827.60
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$1,640.44
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$1,299.56
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$1,505.25
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$2,589.10
|
| Rate for Payer: First Health Commercial |
$2,741.40
|
| Rate for Payer: First Health Workers Compensation |
$1,176.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,741.40
|
| Rate for Payer: GEHA Commercial |
$2,436.80
|
| Rate for Payer: GEHA Medicare |
$1,505.25
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,741.40
|
| Rate for Payer: Humana ChoiceCare |
$1,655.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,505.25
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$2,528.82
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$1,326.03
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$1,505.25
|
| Rate for Payer: Multiplan All |
$2,771.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$2,558.93
|
| Rate for Payer: OMNI Networks Commercial |
$2,132.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,741.40
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$1,531.08
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$1,326.03
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$1,505.25
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,893.70
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$3,010.50
|
| Rate for Payer: Three Rivers Provider Network All |
$2,284.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$1,475.14
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,326.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,505.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,832.78
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$1,505.25
|
| Rate for Payer: Zelis Auto |
$1,218.40
|
| Rate for Payer: Zelis Medicare |
$1,279.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,806.30
|
| Rate for Payer: Zelis Worker's Compensation |
$831.56
|
|
|
INSERTION PICC W/RS&I 5 YR/>
|
Facility
|
IP
|
$3,046.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
8136573
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$831.56 |
| Max. Negotiated Rate |
$2,893.70 |
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$2,589.10
|
| Rate for Payer: First Health Commercial |
$2,741.40
|
| Rate for Payer: First Health Workers Compensation |
$1,176.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,741.40
|
| Rate for Payer: GEHA Commercial |
$2,132.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,741.40
|
| Rate for Payer: Multiplan All |
$2,771.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,132.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,741.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,893.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,284.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,832.78
|
| Rate for Payer: Zelis Auto |
$1,218.40
|
| Rate for Payer: Zelis Worker's Compensation |
$831.56
|
|
|
INSERTION PICC W/RS&I 5 YR/>
|
Facility
|
IP
|
$3,046.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
6136573
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$831.56 |
| Max. Negotiated Rate |
$2,893.70 |
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$2,589.10
|
| Rate for Payer: First Health Commercial |
$2,741.40
|
| Rate for Payer: First Health Workers Compensation |
$1,176.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,741.40
|
| Rate for Payer: GEHA Commercial |
$2,132.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,741.40
|
| Rate for Payer: Multiplan All |
$2,771.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,132.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,741.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,893.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,284.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,832.78
|
| Rate for Payer: Zelis Auto |
$1,218.40
|
| Rate for Payer: Zelis Worker's Compensation |
$831.56
|
|
|
INSERTION PICC W/RS&I 5 YR/>
|
Facility
|
IP
|
$3,046.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
336573
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$831.56 |
| Max. Negotiated Rate |
$2,893.70 |
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$2,589.10
|
| Rate for Payer: First Health Commercial |
$2,741.40
|
| Rate for Payer: First Health Workers Compensation |
$1,176.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,741.40
|
| Rate for Payer: GEHA Commercial |
$2,132.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,741.40
|
| Rate for Payer: Multiplan All |
$2,771.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,132.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,741.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,893.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,284.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,832.78
|
| Rate for Payer: Zelis Auto |
$1,218.40
|
| Rate for Payer: Zelis Worker's Compensation |
$831.56
|
|
|
INSERTION PICC W/RS&I 5 YR/>
|
Facility
|
IP
|
$3,046.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
1000056
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$831.56 |
| Max. Negotiated Rate |
$2,893.70 |
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$2,589.10
|
| Rate for Payer: First Health Commercial |
$2,741.40
|
| Rate for Payer: First Health Workers Compensation |
$1,176.06
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,741.40
|
| Rate for Payer: GEHA Commercial |
$2,132.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,741.40
|
| Rate for Payer: Multiplan All |
$2,771.86
|
| Rate for Payer: OMNI Networks Commercial |
$2,132.20
|
| Rate for Payer: One Health Plan PPO/POS |
$2,741.40
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,893.70
|
| Rate for Payer: Three Rivers Provider Network All |
$2,284.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,832.78
|
| Rate for Payer: Zelis Auto |
$1,218.40
|
| Rate for Payer: Zelis Worker's Compensation |
$831.56
|
|
